The nation should tackle its substance abuse problem from a public
health point of view that emphasizes scientifically proven treatments,
U.Va. law professor Richard J. Bonnie said at an April 20 press conference
at the National Press Club where the creation of Physician and Lawyers
for National Drug Policy: A Public Health Partnership (PLNDP) was announced.

Prof. Richard Bonnie

“Only by using a scientifically based and evidence-driven approach
will we be able to mount a more effective drug policy,” said
Bonnie, who co-chairs the group with Dr. George D. Lundberg, editor-in-chief
of Medscape General Medicine from WebMD. “We’d
like to see less ideology and more science. We want to know what works,
not what sounds best in a campaign speech.”

The initiative builds on the work of Physician Leadership on National
Drug Policy, formed in 1997, and revives a collaboration begun in the
1950s when lawyers and doctors joined to push for pragmatic anti-drug
policies, an effort that eventually resulted in the Controlled Substances
Act of 1970 and other legislation that emphasized treatment programs.

Since then the policy consensus on a public health approach has “unraveled,” Bonnie
said, as politicians have traded accusations about being “hard” or “soft” on
those who sell or use drugs. Meanwhile, too, lawyers and doctors have
developed wary relations over medical malpractice litigation, which
one profession sees as a problem and the other as a solution. The latest
initiative, funded by the JEHT Foundation and the Robert Wood Johnson
Foundation, represents a new pragmatic and non-partisan approach to
national policies that have become polarized and ineffectual, he asserted.

PLNDP’s aim to restore the public health consensus is based
on three ideas, he said. First, drug policies should be evidenced-based
so that accountability is possible. Second, policies must take a public
health approach, emphasizing the health and welfare of people and not
a goal “to stamp out evil.” Third, more innovation should
be encouraged at the state and local level.

More specifically, Bonnie said, the PLNDP will advocate for widespread
alcohol screening at trauma treatment centers and emergency rooms because
about half of patients in these settings had been drinking when they
were injured. Research has shown that alcohol counseling at such times
is “a teachable moment” with positive behavioral results.

“Drunk driving is still a major public health problem and we
need to stay focused on improving policy and practice in this area.
We also need to give much more attention to the most serious drug problem
among our nation’s youth—underage drinking,” said
Bonnie, who recently chaired a National Academy of Sciences study on
the problem. One in eight eighth-graders and 30 percent of high school
seniors report recent heavy drinking and the age of first use is now
14, he said. “The social cost of underage drinking, conservatively
estimated, is $53 billion,” he noted.

“In general, the PLNDP perspective is that drug and alcohol
testing and screening can be a useful public health tool when it can
help identify people in trouble and promote their recovery, but that
it should not be used an instrument of harassment and punishment.”

The PLNDP will also support policies that emphasize treatment rather
than incarceration for non-violent offenders who have drug problems. “The
group will seek to remove legal and financial barriers to treatment
for people addicted to alcohol and other drugs,” he said.• Reported by M. Marshall